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What is it?

Hyperlipidemia refers to elevated levels of lipids (fats) in blood. These lipids include cholesterol and triglycerides. Elevated levels of lipids can significantly increase your risk of heart disease.

Elevated lipids in blood deposit into the walls of blood vessels and form plaque. Constant elevation of these levels can increase the deposits laid in the vessel walls. These plaques restrict the blood flowing through the vessels depriving tissues of the oxygen and nutrients it needs. This plaque has a potential of rupturing. Once the plaque ruptures, a clot will form and further narrow the blood flow to tissues.

This narrowing of the arteries is called atherosclerosis. When atherosclerosis affects the heart it is called coronary artery disease. This causes symptoms of chest pain and can lead to a heart attack. Atherosclerosis of the peripheries is known as peripheral vascular disease which causes symptoms of leg pain while walking called claudication. Atherosclerosis can even narrow the vessels supplying the brain causing dizziness. A clot may dislodge and block a vessel in the brain causing stroke.

Hyperlipidemia can significantly increase a person’s risk of heart attack and stroke!

What causes this?

  • Genetic- hyperlipidemia runs in the family due to a genetic mutation.
  • High saturated fatty diet
  • Obesity
  • Sedentary lifestyle- lack of physical activity
  • Endocrine disease- Diabetes, hypothyroidism, and adrenal disease
  • Kidney disease
  • Liver disease

What are the different types of lipids?

Lipids are made up of cholesterol and triglycerides. Lipids are transported in blood as parts of larger complexes known as lipoproteins.

Blood tests measure the level of your lipoproteins. This blood test is performed here in our clinic with same day results. The measurement of these lipids is known as your lipid profile.

The standard lipid profile measures:

  • Total Cholesterol
  • Low Density Lipoprotein (LDL)
  • High Density Lipoprotein (HDL)
  • Triglycerides
  • Total Cholesterol- this measures all the overall cholesterol components in blood.

This level includes your good and bad cholesterol; therefore this is not an indicator to start medications.

Total cholesterol levels can be checked at any time of the day and does not require fasting.

Normal levels: Below 200 mg/dl

  • Low Density Lipoprotein (LDL) – this is sometimes referred to as your Lousy cholesterol. LDL cholesterol builds up in the arteries making them narrow. Your LDL is the most accurate component for checking the risk of heart disease.

An accurate LDL level is achieved after a 12 hour fast.

Optimal levels: Below 70mg/dl in high risk patients; below 100mg/dl intermediate risks; below 120mg/dl low risk patients

  • High Density Lipoprotein (HDL) – this is sometimes referred to as your Healthy cholesterol. HDL picks up excess cholesterol and takes it back to the liver instead of it accumulating in the arteries. – That’s a good thing!

Like total cholesterol, HDL can be checked at any time of the day without fasting.

Normal levels: Above 60mg/dl

  • Triglycerides- this is found in a type of lipoprotein called very low density lipoprotein. Triglycerides accumulate in the arteries and can be atherogenic.

Triglycerides should be checked with a 12 hour fast for accurate levels.

Normal levels: Below 150mg/dl

Who is at risk?

Positive Risk Factors                                                      Negative Risk Factors

Family history of heart disease                                              High HDL levels

Increasing age

Low HDL levels

Smoking

High Blood Pressure (Hypertension)

Obesity

Poor Diet

Diabetes

Lack of exercise

When should I get my lipid profile done?

Screening should be started at the age of 35 in patients with no risk factors

With risk factors, screening should be started at the age of 20-25.

You must have your lipid profile checked at least once by the age of 45.

Depending on your risk factors and lipid levels, you may be screened every 5 years or more frequently, if risk factors are present.

How is it treated?
Lifestyle changes:

The first line of treatment is lifestyle changes. Lifestyle changes not only treat, but prevent hyperlipidemia.

A few ways you can modify your lifestyle are by:

Quit smoking if you are a smoker.

Reduce the amount of saturated fats and cholesterol you take. Saturated fats include cheese, butter, milk, and red meats.

Add more fruits and vegetables to your diet.

Try eating fish like cod, salmon, or tuna. These are low in fat and have healthy omega 3 fatty acids.

Increase fiber in your diet. This helps in lowering cholesterol levels. Eat more whole grain foods like brown rice and oatmeal.

Reduce your weight. Maintain a BMI below 25.

Exercise for 30 minutes at least 3-4 times a week and be more physically active.

Medications:

Medications are to be used along with lifestyle changes.

Dr. Jamnadas or Dr. Kelly will chose a medication or combination of medications depending on age, risk factors, your present health, and possible side effects of the drug.

After initial therapy, your lipid profile will be monitored at 6 week intervals until target levels are reached. Monitoring will then be done every 6-12 months.

Lipid lowering medications include:

  • Statins- statins are extremely useful in lowering your lousy LDL by 25- 60%. They are also used in the prevention of heart disease. Statins act by blocking a step in cholesterol synthesis in the liver and enhances the clearance of LDL from circulation.

Statins include: Simvastatin (Zocor), Atorvastatin (Lipitor), Lovastatin (Altoprev, Mevacor), Pravastatin (Pravachol), Rosuvastatin (Crestor), and Fluvastatin (Lescol).

  • Bile acid sequestrants- these agents block the absorption of bile acids from the gut that the liver uses to make cholesterol. These help in lowering only mild to moderately elevated LDL and slightly increase HDL.

These may interfere with fat soluble vitamin absorption including vitamins A, D, K, and E. The effects of this can be minimized by taking the drug at different times of the day.

Bile acid sequestrants include: Cholestyramine (Prevalite, Questran), Colestipol (Colestid), and Colesevelam (WelChol).

  • Ezetimibe (Zetia) – this blocks the absorption of cholesterol from the food in your diet.
  • Ezetimibe-Simvastatin (Vytorin) – this is a combination of a statin and ezetimibe. This lowers the absorption of cholesterol from your diet and lowers the synthesis of cholesterol from the liver.
  • Niacin (Niaspan) – is a vitamin that decreases triglyceride levels by limiting the synthesis of LDL and VLDL, and increases HDL.
  • Fibrates– these lower the synthesis of LDL moderately and increase HDL by 10-15%.

Fibrates include: Gemfibrozil (Lopid) and Fenofibrate (Tricor, Triglide).

Alirocumab (Praluent) – Lowers LDL by increasing cholesterol removal by the liver

 

Supplements:

Food and supplements rich in omega 3 fatty acids help reduce triglyceride levels and lower the risk of heart disease.

  • Fish and Fish Oil: are high in omega 3 fatty acids, especially in fish like salmon, herring, and tuna. Fish oil supplements are also high in omega 3 fatty acids.
  • Flax and flaxseed oil: contain omega 3 fatty acids and fiber.
  • Greensoul: is a natural supplement that helps to maintain a healthy cholesterol level, supports the body’s immunity, and the ability to fight free radicals.
  • Coenzyme Q10: helps maintain a healthy cholesterol level, boosts immunity, and energy.

 

What are the complications?

High lipid levels can lead to atherosclerosis. Atherosclerosis can affect any artery in the body and may lead to complications including:

  • Coronary artery disease: can lead to chest pain due to narrowing of the arteries in the heart
  • Heart attack: the complete obstruction of an artery in the heart due to rupture of plaque and clot formation.
  • Peripheral vascular disease: narrowing of the arteries in the legs can lead to leg pain while walking called claudication.
  • Stroke: the complete obstruction of an artery in the brain due to a dislodged clot from a ruptured plaque.

 

How can this be prevented?

Healthy lifestyle changes can lower your chances of having hyperlipidemia. Set goals for yourself and stick to it. Some ways you can help prevent having high lipid levels are:

  • Quit Smokingno_smoking_sign_clip_art_23316
  • Limit alcohol to a maximum of one glass a day if you chose to drink.
  • Eat a low-fat diet with plenty of whole grain foods, fruits, and vegetables
  • Lose excess weight! Maintain a BMI below 25.
  • Exercise for 30 minutes at least 3-4 times a week and be more physically active.

What is it?

An advanced lipid profile is a test used for the identification of additional risk factors for coronary artery disease that may not be detected on a standard lipid profile, despite a normal result.

Early detection of elevated lipid levels can easily be reversed with diet modification and medications. An advanced lipid profile is a successful tool in the detection and management of high cholesterol that can cause serious heart problems.

Early risk factor identification and modification can drastically reduce the morbidity and mortality of heart disease.

Why do I need it?

An advanced lipid profile is usually recommended at your initial visit to our clinic in addition to a standard lipid profile and is intermittently checked throughout treatment.

Standard cholesterol tests may not completely represent the risk for heart attack and strokes. This test is especially useful in patients with diabetes, insulin resistance, or cardiovascular disease who continue to have progression of cardiovascular disease even when their LDL (Lousy cholesterol) and total cholesterol is at their target goal.

This test helps determine the most accurate target number which is best for you, based on your risk factors.

What is it?

An advanced lipid profile measures a variety of markers for cholesterol.

The two tests commonly done are:

  • Apolipoprotein B (ApoB)
  • LDL particle number (LDL-P)

Other tests include:

  • Apolipoprotein A1 (ApoA1)
  • HDL particle number (HDL-P)
  • Small dense LDL (sdLDL)
  • HDL-2
  • Lipoprotein (a) Mass (Lp (a))
  • Lipoprotein-associated phospholipase (Lp-PLA2)
  • Apolipoprotein E (Apo E) Genotype
  • Omega 3 fatty acid
  • Omega 6 fatty acid

An accurate advanced lipid profile is achieved after a 12 hour fast.*

Medications are to be taken as normally the morning of your test. If you are taking diabetic medications, do not take your medications the morning of your test. We will schedule an early appointment in these patients.

You may drink plenty of water during this fast; it will not affect the results of the test.

 

Apolipoprotein B (ApoB) and LDL particle number (LDL-P)

Microsoft PowerPoint - Tom's talk on lipids for borrowing.pptxSince cholesterol can not dissolve in blood, it needs to attach to a lipoprotein to transport cholesterol in blood. HDL particles are known as Apo A and the particles causing atherosclerosis (fatty plaque build up in arteries) are known as Apo B. The majority of circulating Apo B particles are LDL-P.

If there is an increased amount of triglycerides and cholesterol in the blood, an increased amount of Apo B will be driven into the walls of the arteries. A type of white blood cell known as a macrophage comes to the area of Apo B deposition and ingests this foreign material. This process is the hallmark of atherosclerosis.

LDL-P is the most significant predictor of cardiovascular morbidity and mortality. This gives the most accurate number of Apo B particles in circulation; therefore assess the true risk factor for atherosclerosis.

A standard lipid profile shows the overall outlook of cholesterol, it may even be normal, but an advanced lipid profile measures the most accurate LDL levels that can lead to atherosclerosis.

This shows the accurate target number that is required for the management of your cholesterol.

Your physician may advise a combination of diet and drug therapy to prevent the onset and progression of cardiovascular disease.

Apolipoprotein A1 (ApoA1)

HDL particles (Healthy cholesterol) are known as Apolipoprotein A1. Apo A1 helps to clear out cholesterol from your arteries.

High levels of Apo A is associated with decreased risk of cardiovascular disease.

HDL particle number (HDL-P)hdl

An increased amount of HDL-P decreases the risk of cardiovascular disease.

To further increase HDL, diet modification, exercise, and medications can be tried.

Small dense LDL (sdLDL)

Small dense LDL can produce more damage to the arterial wall than just regular LDL.

An LDL level in a standard lipid panel may be normal, but the sdLDL in an advanced lipid will assess your risk.

To lower your risk, diet, and exercise can help reduce sdLDL.

HDL-2

HDL-2 is the best type of HDL which removes cholesterol build up in the arteries.

An increased amount of HDL-2 decreases the risk of cardiovascular disease.

Lipoprotein (a) Mass (Lp (a))

Lipoprotein A is a genetic marker for cardiovascular disease.

An increased level of Lp (a) can increase the risk of cardiovascular risk at an early age.

Lipoprotein-associated phospholipase (Lp-PLA2)

Lp-PLA2 is a specific marker for vascular inflammation which can make fatty plaque build up within the artery prone to rupture.

Elevated Lp-PLA2 is a powerful predictor of heart attack and stroke.

Apolipoprotein E (Apo E) Genotype

Apolipoprotein E is a genetic marker for those who are more prone to high cholesterol levels.

Apo E comes in different forms including Apo E2, Apo E3, and Apo E4.

Apo E2 and Apo E3 patients respond well to statin drugs.

Fish oil is known to benefit Apo E2 and Apo E3 patients.

Apo E4 patients typically do not respond well to statin drugs but respond well with diet modification.

Elevated Apo E levels increase the risk of cardiovascular disease, especially in Apo E4 patients, as well as early-onset Alzhemers.

Patients with Down Syndrome are likely to have increased Apo E4

This is also useful in the prediction of a patient’s responsiveness to cardiac-related environmental factors, diet, and drug therapy.

Omega 3 fatty acid

Omega 3 fatty acids reduce the risk of cardiovascular disease.

A good source of omega 3 fatty acids come from oily fish and fish oils.

Omega 6 fatty acid

Omega 6 fatty acid reduces the risk of cardiovascular disease.

Oily fish and fish oil are a good source of omega 6 fatty acid.

Results:

The results of your test will return within 7 days.

Your test results will be discussed with you during your next scheduled visit. Diet or drug therapy may be advised or altered.

Your test results will be reflected in a chart form similar to the one below.

Your test result may fall under an optimal range, intermediate risk range, or high-risk range.

Optimal Range

IntermediateRiskRange

HighRiskRange

Apo B (mg/dL)

<60

60 – 79

≥ 80

LDL-P (nmol/L)

< 1000

1000 – 1299

≥ 1300

Apo A1 (mg/dL)

≥ 151

130 – 150

< 130

HDL-P (µmol/L)

≥ 35

28 – 34

<28

sdLDL (mg/dL)

< 20

21 – 30

≥ 31

HDL-2 (mg/dL)

≥ 17

13 – 16

≤ 12

Lp (a) Mass (mg/dL)

< 30

≥ 30

Lp-PLA2 (ng/mL)

< 200

200 – 234

≥ 235

Apo E Genotype

2/2 – 2/3

2/3

3/4 – 4/4

Omega- 3 Total

0.1% – 14.1%

Omega- 6 Total

28.6% – 44.5%

 

 

What is it?


Lipoprotein (a), also called Lp (a), is a modified form of LDL cholesterol bound to the protein apolipoprotein.

Elevated levels of lipoprotein (a) may promote atherosclerosis which is a risk factor for coronary artery disease.

There is a fundamental relationship of lipoprotein (a) excess with the risk of heart attack.

lipoa

 

How am I at risk of a heart attack?

Lp (a) is a modified LDL (lousy cholesterol) in which a large protein, apolipoprotein (a) is bound to apolipoprotein B. Apolipoprotein (a) is a specific marker of Lp (a).The apolipoprotein (a) chain has five domains. One of the domains is similar to a fibrin-binding domain of plasminogen that dissolves clots. Because of the similar structure with plasminogen, Lp (a) interferes with the protein that dissolves clots.

Lp (a) also binds to a type of white blood cell that promotes the formation of fatty cells in the arterial walls called foam cells. Lp (a) deposits cholesterol into atherosclerotic plaques that narrow blood vessels in the heart.  Inflammation begins within these plaques and leads to a thickening of the arterial wall. This further narrows the blood vessels depriving the heart muscle and body tissue of oxygen rich blood.

Therefore, plaque formation, inflammation and altered plasminogen activity increase the risk of heart attack.

Both genetic and environmental factors including age, sex, race, and ethnic background influence the risk of coronary artery disease.

 

What diseases can occur with high Lp (a) levels?

High Lp (a) levels in blood increases the risk for:

  • Coronary artery disease (CAD)
  • Cerebrovascular disease (CVD)
  • Atherosclerosis
  • Thrombosis
  • Stroke

 

Who should be screened?

Patients with a moderate or high risk of cardiovascular disease are recommended to have their Lp (a) levels checked.

Any patient with the following risk factors should be screened.

  • Premature cardiovascular disease
  • Familial hypercholesterolemia
  • Family history of premature cardiovascular disease
  • Family history of elevated lipoprotein (a)
  • Recurrent cardiovascular disease despite cholesterol lowering treatment with a statin drug
  • ≥10% 10-year risk of fatal and/or non-fatal cardiovascular disease

There are no signs or symptoms of elevated lipoprotein (a), although Lp (a) levels are assessed by performing a simple blood test for an advanced lipid profile.

Even those who are not at risk are recommended to have an advanced lipid profile done at least once to assess accurate lipid levels.

 

How is it treated?

High Lp (a) levels are hard to treat, yet some medications are available to lower these levels.

The medications available to lower elevated Lp (a) levels are:

  • Niacin (vitamin B3)
  • Fibrate drugs  (gemfibrozil/ fenofibrate)

Niacin 1-3 grams daily can reduce lipoprotein (a) levels by 20-30%.

Atorvastatin, aspirin, coenzyme Q10, L-carnitine, gingko biloba may be beneficial as well.

When elevated Lp (a) levels are discovered in a patient, attention towards other more easily treatable risk factors should be increased. These include high LDL cholesterol levels, smoking, and leading a sedentary lifestyle.

Lipoprotein (a) levels:

  • Desirable < 14 mg/dL
  • Borderline risk: 14-30 mg/dL
  • High risk: 31-50 mg/dL
  • Very high risk: >50 mg/dL

What is it?

Atherosclerosis is the build-up of fat and cholesterol-filled plaques inside the artery walls, which can restrict blood flow.

These plaques have the potential to rupture leading to the development of a clot. A clot may restrict blood flow further or dislodge and obstruct another vessel.

Atherosclerosis increases the risk of cardiovascular disease including heart attack and stroke.

Atherosclerosis can affect any artery in the body and is a preventable and treatable condition.

How does it occur?

At a young age, fat can start to deposit within the blood vessel walls. Fat builds up over the years can cause injury to the blood vessel walls.

Not only fat, but a number of other substances in blood including inflammatory cells, cellular waste products, proteins, and calcium begin sticking to the inside of vessel wall. All of these substances collectively form what is called Plaque.athero1

athero2

 

Many of the plaque deposits have a soft inner center and hard exterior. If the hard outer surface breaks or tears, the soft inner center will become exposed to our body’s platelets.

The platelets will come to the area of breakage and form a clot around the plaque. This further narrows the artery and restricts blood flow.

A clot may dislodge and permit blood flow again, but the dislodging of a clot can also be dangerous, as it can travel further downstream and cause a blockage.

What are the symptoms?

Atherosclerosis can affect any artery in the body. When this condition affects the vessels of the heart it is known as coronary artery disease. Atherosclerosis affecting all other arteries excluding the coronary arteries, it is known as peripheral vascular disease. Atherosclerosis of the vessels that supply the brain can cause as a stroke and may lead to dementia.

Peripheral vascular disease can affect the arteries of the neck, arms, kidneys, legs, etc. Symptoms depend on the part of the body that is affected although; more than one area can be affected.

Coronary artery disease: Symptoms may include chest pain (angina), shortness of breath, dizziness, palpitations, sweating, extreme weakness, fast heartbeat, or nausea.

Peripheral vascular disease:

  • Peripheral Vascular Disease: includes symptoms of claudication (pain in the legs while walking), cold feet, tingling or numbness in the legs, slow healing of cuts or sores on the feet and legs, pale, shiny, or bluish skin, brittle and slow growing nails, loss of hair over the limbs, absent or weak pulse in the legs or feet, or erectile dysfunction
  • Carotid Artery Disease (narrowing of the artery in the neck): symptoms of syncope or fainting, dizziness, or blurring of vision.
  • Renal Artery Disease (narrowing of arteries in kidney): symptoms of high blood pressure.

What are the causes of atherosclerosis?

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes

What are the risk factors? 

Non-modifiable risk factors:

  • Age: Old age
  • Sex: Men have a greater risk of atherosclerosis than women. The risk increases in woman after menopause due to less hormone production of estrogen
  • Race: African Americans have more severe high blood pressure than Caucasians. Indians have more diffuse coronary artery disease.
  • Family history of medical diseases associated with cardiovascular disease

Modifiable risk factors:

no_smoking_sign_clip_art_23316

  • Smoking
  • Excessive alcohol consumption
  • High blood pressure
  • High blood cholesterol levels
  • Uncontrolled diabetes (HbA1c >7.0)
  • Sedentary lifestyle- lack of physical activity is associated with atherosclerosis
  • Obesity
  • Obstructive sleep apnea
  • Chronic inflammation- even having the flu can be a risk because it is a form of inflammation. C-reactive protein is a marker of inflammation and high levels of this can show an increased risk of atherosclerosis.
  • Stress
  • Homocysteine – is an amino acid in the body that helps make protein and maintain tissue. Elevated levels of this can increase the risk of atherosclerosis
  • Fibrinogen- is a protein in the body that aids in blood clotting. An increase in this can increase platelet clumping leading to the formation of clots.

What are the complications?

Complications of atherosclerosis depend on the location of the narrowed or blocked artery.

Coronary artery disease: Complications of coronary artery disease include chest pain (angina), heart attack, congestive heart failure, arrhythmia (abnormal heart rhythm), or pericarditis (inflammation of a layer of the heart).

Peripheral vascular disease:

  • Peripheral Vascular Disease: Complications include permanent tingling, numbness, or weakness in the legs or feet, permanent burning or aching pain, leg or foot ulcers, or gangrene (death of a part of the body due to lack of blood supply. Treatment requires amputation of the affected part)
  • Carotid Artery Disease: transient ischemic attack (TIA) or stroke
  • Renal Artery Disease (narrowing of arteries in kidney): kidney failure

How is it diagnosed?

Your provider / Dr. Jamnadas or Dr. Kelly will have a better idea if you have atherosclerosis by:

  • Discussing with you about your symptoms, medical and family history, and risk factors.
  • Physical examination- blood pressure will be recorded, peripheral pulses will be felt, and the physician may listen to your arteries for an abnormal whooshing sound called a bruit that may indicate poor blood flow.
  • Blood tests- to assess increased levels in cholesterol or elevated blood sugar levels.
  • Performing diagnostic tests including:

Electrocardiogram (EKG) – records the electrical activity of the heart. This may show evidence of a current or previous heart attack.

Ankle Brachial Index (ABI) – this is a non-invasive test measuring the ratio of blood pressure in the ankle to your arm. If the value is lower than expected, this may indicate a vascular problem. You may be required to walk on a treadmill and have readings taken before and after exercise.

Ultrasound Doppler Test- helps to evaluate the blood flow through a vessel and identify the site of blocked or narrowed arteries.

Echocardiogram (ECHO) – shows the images of the heart which determines whether the heart walls and pumping activity are normal or performing weakly.

Stress test- helps access the blood flow to the heart at rest and during stress. Will detect if any areas receiving less blood flow.

Chest x-ray- reveals signs of congestive heart failure.

Angiogram- used to locate the exact anatomical site of blockage by injecting a dye into the arteries, which is visualized on x-ray showing the amount of blood flow to an area, and the number, size, and location of any blockages.

Computerized tomography (CT) – helps visualize your arteries. Sometimes an electron-beam computerized tomography (EBCT) is offered to detect calcium within fatty deposits in narrowed arteries.

How is it treated?

The treatment for atherosclerosis may include lifestyle changes, medications, or procedures.

It is very important to reduce any risk factors in order to manage the symptoms and progression of atherosclerosis.

Lifestyle changes

 

  • Quit smoking!!
  • Limit alcohol intake if you chose to drink.
  • Lower blood sugar levels
  • Maintain a normal blood pressure and cholesterolfiber
  • Eat a well-balanced diet.
  • Eat foods high in fiber such as whole grain cereals, oatmeal, and figs. Eat plenty of fruits such as apples, bananas, prunes, oranges, and pears. Include fish and legumes such as beans or chickpeas.
  • Lower your salt intake.
  • Avoid fatty foods including bad saturated fat that is found in some meats, dairy products, chocolates, baked goods, and deep-fried food.
  • Exercise regularly for 30 minutes at least 3-4 times a week and be more physically active.
  • Maintain a healthy weight with a BMI below 25.foot ulcer
  • If you have diabetes, practice proper foot care and prevent injury to the foot. Avoid walking barefoot and wear proper shoes. Maintain toenails and skin care. Be sure to inspect the soles of your feet regularly.
  • Relax and reduce stress.

For some people, these changes may be the only treatment needed.

Medications

If lifestyle changes are not enough to control the effects of atherosclerosis, medications may be prescribed to you including:

  • Cholesterol-lowering medications– these act by decreasing the amount of cholesterol in the blood, especially Lowering your low-density lipoprotein (LDL- your Lousy cholesterol) and keep your high-density lipoprotein (HDL- your Healthy cholesterol) High.
  • Aspirin – is an anticoagulant that prevents platelets from clumping together. This reduces the chances of a blood clot narrowing or obstructing the arteries. This may not be appropriate for all patients including patients with bleeding disorders or already taking an anticoagulant.
  • Beta blockers- slow your heart rate and reduce blood pressure which decreases the oxygen demand of the heart.
  • Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin receptor blockers (ARBs) – help dilate the blood vessels and lower the blood pressure so the heart does not have to work as hard and improve the lining of arteries. causes positive remodeling of the blood vessels over time.
  • Calcium Channel Blockers- medication that helps relax the muscles surrounding the coronary arteries and cause the vessels to open leading to an increase in blood flow to the heart and lowering blood pressure.

Supplements

Food and supplements rich in omega 3 fatty acids help reduce inflammation throughout the body, lower blood pressure, and the risk of heart attack.

  • Fish and Fish Oil- are high in omega 3 fatty acids, especially in fish like salmon, herring, and tuna. Fish oil supplements are also high in omega 3 fatty acids.
  • Flax and flaxseed oil- contain omega 3 fatty acids and fiber.
  • Greensoul- is a natural supplement that helps to maintain a healthy cholesterol level, supports the body’s immunity, and the ability to fight free radicals.
  • Coenzyme Q10- helps maintain a healthy cholesterol level, boosts immunity, and energy.
  • Perfusion SR- helps enhance blood flow, maintain a normal blood pressure, and enhance the elasticity of large arteries.

Procedures to restore blood flow

Angioplasty and stent placement: this is a procedure considered as non-surgical because it is done by Dr. Jamnadas or Dr. Kelly, who accesses the artery by inserting a long, thin tube (catheter) into the narrowed part of your artery while being visualized under x-ray.

A wire with a deflated balloon is passed through the catheter to the narrow area. The balloon is then inflated, compressing the plaque against the artery wall and widening it, so it no longer restricts blood flow.

 

angio1angio2

 

Blocked arteries supplying the heart, kidneys, legs, arms and brain can easily be treated with stenting or endarterectomy.

Unlike stenting done in the coronary arteries, only bare metal stents are used in the peripheries. Bare metal stents act as a scaffolding to keep an artery open but suffer a 30% re-stenosis rate. This is due to a process called intimal hyperplasia which is attributed to a keloid like growth. A keloid is an overgrowth of the inner lining of the blood vessel that covers over the stent.

However, this reparative process lasts no more than 6 months. After 6 months, if an artery has not re-narrowed at the site of the stent, it is unlikely to re-narrow.

If symptoms were to reoccur, it would be due to New blockages at another site within the arteries.

**Patients will need to improve risk factor modifications to prevent New blockage formation.

  • Endarterectomy: is a procedure where a catheter is used to scrape the inner lining of an endartartery. That material which is blocking the artery is extracted and then taken out of the artery using the catheter. The procedure is Best suited for blocked arteries in the legs. Laser atherectomy has been used in the legs also, but Dr. Jamnadas does not favor it at this time due to the high re-stenosis rate.
  • Bypass Surgery: is performed by removing a portion of a small blood vessel and seBypass_Surgerywing or ‘grafting’ one end of the bypass proximal to the area of blockage and the other end beyond the area of blockage, therefore bypassing the affected area.
  • Enhanced
    external counterpulsation (EECP): This is for patients who have angina (chest pain) and have already exhausted the standard treatments without successful results or for those who do not qualify for the other treatment regimens. This is a non-invasive procedure which promotes the formation of collaterals to bypass the clogged arteries as another means of getting oxygen rich blood to those areas of the heart that are not getting it. This is carried out in our office daily for 7 weeks.Blausen_0161_Cardiac_Enhanced_External_Counterpulsation

How can I prevent this?

 

  • Do not smoke!
  • Maintain a healthy weight with a BMI <25
  • Maintain a normal blood pressure, cholesterol and sugar levels.
  • Eat nutritious, low-fat foods and avoid foods high in cholesterol.
  • Exercise regularly for 30 minutes at least 3-4 times a week.

Reducing Your Risk of Coronary Heart Disease
It’s the Type of Fat – Not the Amount of Fat

Although many people believe that reducing their intake of dietary fat will lower their risk of coronary heart disease (CHD), recent studies show that the type of fat—not the amount of fat—consumed influences cardiovascular risk.(1) Despite a decrease in total fat consumption in the United States, there has not been a decline in total caloric intake; additionally, the prevalence of type 2 diabetes and obesity has increased, suggesting that there is another dietary factor influencing cardiovascular risk.1 This factor is the type of fat consumed; different types of fats have different effects on health.

Challenging the Low-Fat Diet
Results of a prospective cohort study assessing dietary choices of 80,082 women with no cardiovascular disease at baseline showed that each 5% energy intake from saturated fat was associated with a 17% increase in the risk of coronary disease.2 The study concluded that replacing saturated and trans fats with unhydrogenated, monounsaturated, and polyunsaturated fats is more effective at preventing CHD than is following a low-fat diet.(2) This is because low-fat, high-carbohydrate diets raise HDL cholesterol levels and raise fasting triglyceride levels, which increases cardiovascular risk.2

Why is Saturated Fat Bad?
Saturated fatty acids increase total cholesterol and LDL cholesterol levels; elevated lipid levels are a risk factor for cardiovascular disease.1 In the Nurses’ Health Study, there was an increase in cardiovascular disease risk with each intake of saturated fatty acids.1 Both saturated and trans fat intake are associated with higher LDL levels and lower HDL levels, which increase cardiovascular disease risk. Additionally, trans fat consumption increases lipoprotein(a) levels, which are also associated with cardiovascular disease.

What is Monounsaturated Fat?
Both monounsaturated and polyunsaturated fats are liquid at room temperature. Polyunsaturated fats help your body to rid itself of newly synthesized cholesterol, keeping blood cholesterol levels low. Both fats keep your blood cholesterol levels low when substituted in place of saturated fats.

Studies have shown an inverse relationship between consumption of monounsaturated fats and total mortality.1 In fact, mortality rate of cardiovascular heart disease is very low in traditional Mediterranean populations that consume olive oil (a monounsaturated fatty acid source) as their primary source of fat.1 In metabolic studies, substituting carbohydrates with monounsaturated fats raises HDL levels without affecting the LDL levels. This may also improve glucose tolerance and insulin sensitivity among diabetic patients.

Now What?
In your diet, you should replace saturated and trans fats with monounsaturated and polyunsaturated fats. This will lower your lipid profile as well as your risk of CHD. Also, you should exercise at least 20 minutes a day, most days of the week, to ensure optimal cardiovascular health. In fact, a combination of diet and lifestyle changes is associated with decreased progression of atherosclerosis. The Lifestyle Heart Study assigned 28 MI patients to an intervention consisting of a low-fat, vegetarian diet, exercise, and yoga.1 The other 20 individuals were assigned to usual care group.1 After one year, the blood cholesterol was lowered by 19% in the intervention group, compared with the control group.1 This shows the benefits of both a healthy diet and exercise.

Dietary Sources of Trans Fats: Stick margarine, commercially baked products, deep-fried foods, partially hydrogenated vegetable oils (cookies, crackers, French fries, donuts)

Dietary Sources of Saturated Fats: some plant oils (palm, palm kernel, and coconut oils), foods from animals (whole milk, ice cream, lard, meats).

Dietary Sources of Polyunsaturated Fats: nuts (walnuts, almonds, peanuts, and other nuts), certain plant oils (safflower, sesame, soy, and others)

Dietary Sources of Monounsaturated Fats: certain plant oils (olive, canola, peanut), avocados

  • Please refer to our Heart Healthy recipes under the Educational Resource Center for healthy recipes for all occasions.

Updated February 12, 2009 – MJ

(1) Hu, F.B., Manson, J.E., & Willett, W.C. (2001). Types of dietary fat and risk of coronary heart disease: A critical review. Journal of the AmericanCollege of Nutrition, 20(1), 5-19.

(2) Hu, F.B., et al. (1997). Dietary fat intake and the risk of coronary heart disease in women. New England Journal of Medicine, 337(21), 1491-1499.